Individual
BLAISE LOLIKA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3130 S PORTIA AVE, TUCSON, AZ 85730-1449
(520) 881-4813
Mailing address
3130 S PORTIA AVE, TUCSON, AZ 85730-1449
(520) 881-4813
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
BH4758
AZ
385H00000X
Respite Care
BH-4758
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093847
—
AZ
01
—
BH-4758
AZ DEPT OF HEALTH SVCS
AZ
Enumeration date
12/10/2015
Last updated
05/09/2024
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